The epidemic of overdose deaths in Allegheny County and beyond will almost certainly get worse before it gets better, Allegheny County Medical Examiner Dr. Karl Williams said Friday.

That means the 2016 death toll – 610 overdose deaths last year – is likely not the highest the county will see. Roughly 75 percent of overdose cases that passed through the medical examiner's office last year involved heroin, fentanyl or both.

Overdose deaths containing fentanyl increased from 63 in 2014 to 126 in 2015 and, last year, to 387.

Williams said the narrative of opioid users getting their start on prescription painkillers and moving on to heroin is beginning to peak.

"There is a new population going directly to injectable drugs," Williams said.

The rise of fentanyl and other synthetic drugs, like carfentanil, a drug used to tranquilize elephants, means that drug users often have no way of knowing exactly what's in the drugs they buy.

Williams said that while there have been no carfentanil-related overdoses in Allegheny County, they have seen the drug in some of the seizures the lab has analyzed.

In addition to performing autopsies, the office is also a crime lab, and thus investigators test all the drugs seized by police.

The rise in overdose deaths has overloaded his office, he said.

"We have been maximally stressed by the increase and the sophistication of the drugs," he said.

Autopsies can number up to 10 per day, and the overall number per year has increased along with overdose deaths: 1,100 in 2014, 1,200 in 2015 and 1,400 last year, he said.

The mixtures of drugs have become so sophisticated, he said, that samples must sometimes be sent out to larger labs to determine what, exactly, is in the mixture.

"That's why we're here in April trying to wrap up (last year)," he said.

Megan Guza is a Tribune-Review staff writer. Reach her at 412-380-8519 or mguza@tribweb.com.

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